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Post-operative Analgesia for Ambulatory Mastectomies: Serratus anterior plane catheter vs Liposomal bupivacaine

Zakiya Maryam1, Franklin Wou2, Madan Naryanan1, Hisham Harb1, Isabella Karat1, Hisham Osman1, Karin Cannons1

1Frimley Park Hospital, Frimley, United Kingdom. 2Guy's and St Thomas', London, United Kingdom


Introduction: Effective pain management after major breast surgery can accelerate patient recovery. (1) To enhance postoperative analgesia and day-case rates at our hospital we compared two regional techniques currently in use at our trust.

Method: We prospectively reviewed 37 mastectomies (September 2021 - March 2023). The patients either received serratus anterior plane catheters through which local anaesthetic was delivered for up to 72 hours postoperatively or preoperative serratus anterior plane blocks using Liposomal Bupivacaine. We compared the postoperative pain scores and opioid requirements between the 2 groups.

• Statistically significant lesser pain scores were observed at rest immediately postoperative and on post-operative days (POD) 1 and 2 with Liposomal Bupivacaine.
• There was no difference in pain scores at all time points on movement.
• The use of rescue fentanyl in PACU in the Liposomal Bupivacaine group was significantly lower.
• There was no significant difference in need for oral opioids in PACU or at home on PODs 1 and 2.
• Both methods provide similar pain relief and reduce need for rescue analgesia after mastectomy for 48 hours postoperatively.
• Pain relief with the liposomal bupivacaine may be marginally better - with a statistically significant difference in pain scores at rest. This may be due to complications associated with catheter techniques (primary or secondary failure, catheter leakage, suboptimal LA regime).
• Liposomal bupivacaine has an advantage of requiring less manpower and in-person follow up.

1. Chai et al. Research Progress on Serratus Anterior Plane Block in Breast Surgery: A Narrative Review. PainTher 2023, 323–337.